BackgroundSeveral African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs’ performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community.MethodsThis study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance.ResultsThe significant factors associated with the CHWs’ performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors’ better health knowledge and the number of supervisions.ConclusionA high quality of routine supervisions is one of the key interventions in sustaining a CHW’s performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.

This study challenges the orthodox concept of mate selection. Existing research presupposes the binary conceptualization of 'arranged marriage versus love marriage,' which is too limited in scope to grasp the reality of transition in mate selection. An alternative model is proposed in this study and is applied to data from Japan, Korea, and Taiwan. Analyses suggest that a considerable number of cases cannot be described as either 'traditional' or 'love' marriages; these are considered transitional cases. In some cases, the couple's first meeting is initiated by free will but with strong parental intervention regarding the decision to marry. In other cases, the first meeting is arranged by parents or kin, but the couple maintains free will. Three countries share basic trends regarding the shift between the types of mate selection, and an analysis shows that national differences regarding certain factors also explain the shift.

There is considerable imbalance in the household division of labor in industrialized societies, where wives do an undue amount of housework. Nevertheless, many wives perceive the division of household labor as fair. Gender perspective explains this by the fact that wives with a traditional gender ideology are less likely to express a sense of unfairness. In addition to this explanation, we expect that social environments influence perceptions of fairness. That is, the average level of the division of housework in a given society influences perceptions of fairness, as individuals may use it for assessing their own situation. Using cross-national data on the household division of labor and the associated perceptions of fairness, we found that wives in countries where wives do most of the housework and where traditional gender ideologies are strong tend to report lower levels of perceived unfairness, even when they do most of the housework, work long hours, and have a high educational attainment.

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In a simple theoretical framework, egalitarian gender role attitudes emerge as more and more women participate in the labor market. Most advanced Western nations enjoy relatively gender-egalitarian working environments, and consequently more egalitarian gender attitudes than their East Asian counterparts. Women in East Asian societies, on the other hand, are said to support both the conditions resulting in stagnant female labor-force participation and traditional attitudes toward gender roles. In Taiwan, however, women are more economically active than in two other East Asian societies-Japan and South Korea-even though women in all three societies favor the traditional gender division of labor. Thus, in Taiwan, women experiencing inconsistencies between their active working lives and their traditional values. This study hypothesizes that this inconsistency, or the coexistence of the old and the new, is reflected in the very mind-set of women. Using comparative data from the 2006 East Asian Social Survey, we analyzed the gap between responses to questions on gender attitudes in relation to working conditions, and other general gender role attitudes. We found there were significant differences in the size of these gaps. Taiwanese women expressed more egalitarian views insofar as the questions were concerned with practical economic interests, while they retained their basic traditional attitudes towards gender roles in their homes. This gap is larger in Taiwan than in Japan or South Korea.